INJURIES AND SYNTHETIC TURF IN INTERNATIONAL RUGBY BOARD INTRODUCTION In Rugby Union synthetic turf is used widely across the globe. The advantages such as longer playing hours, lower maintenance costs, better resilience to tough climatic conditions and the multi-purpose application make synthetic turf a valuable alternative to natural grass in most regions of the world. There are many reports on the risks of injury injury risk and playing surface in football, such within international rugby, comparing different as limited data collection, various influencers on positions, type and severity of injuries and injury risk that cannot be reduced to one single the time of the match when an injury occurs. cause and bias within data collection, both for The research on causal relationships between players and team medical staff. In this research playing surface and injury risk is rather limited. paper however we will have a brief look on the One reason for this might be the limitations of few existing papers on injury definitions and the scientific research that have been identified in injury risk in international rugby when playing an earlier paper on the relationship between on synthetic turf compared to natural grass. DEFINITIONS In order to understand the incidence of injury on synthetic turf and on natural grass some basic definitions have to be discussed. Fuller et al. (2007) discussed injury definitions and data collection procedures for studies on injuries in rugby union. Their discussion is based on the consensus statement by the Rugby Injury Consensus Group (RICG) and focusses in particular on the differences towards injury definitions and data collection procedures in football. What is an injury? According to the consensus For the classification of injury severity the consensus statement it covers: statement for rugby differentiates between 7 stages ranging from slight (0-1 days that elapsed from the Any physical complaint, which was caused by a transfer date of injury to the date of the player’s return to full of energy that exceeded the body’s ability to maintain its participation in team training and availability for match structural and/or functional integrity, that was sustained selection), minimal (2-3 days), mild (4-7 days), moderate by a player during a rugby match or rugby training, (8-28 days), severe (>28 days) and career-ending and irrespective of the need for medical attention or time-loss non-fatal catastrophic injuries. from rugby activities. An injury that results in a player receiving medical attention is referred to as a ‘medical- Also the injury classification was slightly changed and attention’ injury and an injury that results in a player few categories have been added to the consensus being unable to take a full part in future rugby training or statement for football. Table 1 shows main groupings match play as a ‘time-loss’ injury. (Fuller et al., 2007:329) and categories for classifying the type of injury as it has been used by Fuller et al. (2007). Another speciality with international rugby are non- fatal catastrophic injuries which are defined as ‘a brain Table 1 (based on Fuller et al., 2007:330) or spinal cord injury that results in permanent (>12 Main Grouping Category months) severe functional disability’ (Fuller et al., 2007:329). Bone Fracture Other bone injuries Recurrent injuries have been classified into three Joint (non-bone) Dislocation/ subluxation subgroups including ‘early recurrence’, ‘late recurrence’ and ligament Sprain/ ligament injury and ‘delayed recurrence’, depending on when the Lesion of meniscus, cartilage or disc recurrent injury occurs. A recurrent injury is: Muscle and Muscle rupture/ tear/ strain/ cramps tendon Tendon injury/ rupture/ tendinopathy/ An injury of the same type and at the same site as an bursitis Haematoma/ contusion/ bruise index injury and which occurs after a player’s return to full participation from the index injury. A recurrent Skin Abrasion injury occurring within 2 months of a player’s return to Brain/ spinal Concussion (with or without loss of full participation is referred to as an ‘early recurrence’; cord/ peripheral consciousness) nervous system Structural brain injury one occurring 2 to 12 months after a player’s return Spinal cord compression/ transection to full participation as a ‘late recurrence’; and one Nerve injury occurring more than 12 months after a player’s return to Dental injuries full participation as a ‘delayed recurrence’. (Fuller et al., Visceral injuries Other injuries 2007:329) RISK OF INJURY ASSOCIATED WITH RUGBY UNION PLAYED ON SYNTHETIC TURF COMPARED TO NATURAL GRASS Fuller, Clarke and Molloy (2010) conducted an investigation on the relationship between injury risk and playing surface covering a two-season investigation of match and training injuries. The setting chosen for the study included six men’s significant differences have been found for synthetic teams playing in the Hong Kong Rugby Football turf and natural grass. Union Division 1. None of the clubs owns their rugby grounds, so the Hong Kong Rugby Football Key conclusions discussed by the authors include: Union assigns matches randomly to available grass a. Match injuries on both grass and artificial turf and synthetic turf pitches. As the clubs also do not own their facilities training is rather irregular surfaces were predominantly acute in nature and making it impossible to collect meaningful the result of player-to-player contact; these injury data on this. Therefore two clubs in the English factors are unlikely to be related directly to the Premiership that conduct a proportion of their playing surface. training on synthetic turf have been chosen for the study of training injuries. b. It is claimed that, because athletes adapt quickly to changes in surface conditions, any differences The authors found no significant difference on the between playing surface characteristics will have overall incidence or severity of match or training minimal impact on the incidence of injury. injuries sustained on both surfaces. Also in terms of injury location and type or cause of injury no both Fuller et al., 2010:568 CONCLUSION Only limited research exists on the causal In order to enable a better evaluation on the relationship between injury incidence and playing impact of playing surface in rugby it would be surface in international rugby. However the one and useful to include a note on the surface in the injury only paper that is referred to on all available sources surveillance reports. This would generate a vast including the World Rugby Federation concludes amount of data within a short time period and that the playing surface is not a decisive factor for could result in meaningful and significant findings. injury incidence. The fact, that research is limited on Especially in order to increase the acceptance rate for the playing surface but not on injury surveillance synthetic turf having statistically significant reports at different international rugby tournaments, could showing that injury risk is comparable or even lower also indicate that the question of synthetic turf or compared to natural grass would be beneficial. natural grass is rather irrelevant for rugby compared to football. It seems to be accepted that rugby is Appendix 1 gives an overview on synthetic turf a sport in which serious injuries might result from pitches used for international rugby worldwide, player-to-player impacts rather than from player-to- emphasizing the high need and acceptance of surface or non-contact events. synthetic turf in the sport. REFERENCES Fuller CW, Ekstrand J, Junge A, Andersen TE, Bahr R, Dvorak J, Hägglund M, McCrory P, Meeuwisse WH (2006). Consensus statement on injury definitions and data collection procedures in studies of football (soccer) injuries. Br J Sports Med, 40:193–201. Fuller CW, Molloy MG, Bagate C, Bahr R, Brooks JHM, Donson H, et al. (2007). Consensus statement on injury definitions and data collection procedures for studies of injuries in rugby union. British Journal of Sports Medicine, 41:328-331. Fuller CW, Clarke L, & Molloy MG (2010). Risk of injury associated with rugby union played on artificial turf. Journal of Sports Sciences, 28:563-570. Hägglund M, Walden M, Bahr R, et al (2005). Methods for epidemiological study of injuries to professional football players: developing the UEFA model. Br J Sports Med, 39:340–6. Walden M, Hägglund M, Ekstrand J (2005). Injuries in Swedish elite football: a prospective study on injury definitions, risk for injury and injury pattern during 2001. Scand J Med Sci Sports, 15:118–25. World Rugby. List of Regulation 22 Compliant Preferred Producer Installed Pitches. Accessed on May 29, 2015 at http://playerwelfare.worldrugby.org/?subsection=71 . APPENDIX Andorra Estadi Nacional Andorra Canada Goudy Field, 1089 Langford Parkway, Langford, BC Canada UBC Thunderbird Stadium, Vancouver, BC Canada University of Western Ontario, Philip Aziz Avenue, London, Ontario Canada Westhills Stadium, Langford Parkway. Langford, BC England Allianz Park, Hendon, London England BNRC Dartmouth England Burnage RFC, Stockport. UK England Driffield RUFC, Yorkshire England Dyson Perrins Church of England Academy, Malvern, Worcestershire England Haddington Athletic Community Football Club, Haddington, East Lothian England Hampton School, Hansworth Road, Middlesex England Hampton School, Middlesex England Kirkstall Training Ground, Kirkstall, Leeds England Maidenhead RFC, Braywick Road, Bershire England Newcastle Falcons (Training Ground),